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GPhC Exam Revison > Respiratory System > Flashcards

Respiratory System Flashcards

1
Q

What is the BTS/SIGN guidelines for the management of asthma?

A

SABA used in all stages as reliever

Step 1: Low dose ICS
Step 2: Add LABA (with low-dose ICS)
Step 3: Increase dose of ICS, or add LTRA, LAMA or theophylline
Step 4: High dose ICS, or add another drug
Step 5: oral steroid

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2
Q

When should step up therapy be considered in asthmatics?

A

If using their inhaler >3 times a week
If having night time symptoms at least ONCE a week
If they have had an asthma attack within the last 2 years

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3
Q

What are the NICE guidelines for the management of asthma?

A

SABA used in all stages as reliever

Step 1: Add low dose ICS
Step 2: Offer LTRA + ICS
Step 3: Add LABA (alongside ICS + LTRA)
Step 4; Switch to MART therapy
Step 5: Increase ICS dose

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4
Q

What are some side effects of B2 agonists?

A

Arrhythmia
Hypokalaemia
Palpitations
Tremor
Hyperglycaemia

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5
Q

How often are inhaled LABAs given in a day?

A

Twice a day

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6
Q

What is the maximum number of salbutamol puffs a person take in a day?

A

Max. 1-2 puffs four times a day

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7
Q

Which brands of inhalers are only used for >18 years old?

A

Fostair
Duoresp Spiromax
Symbicort

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8
Q

What are the active ingredients in Fostair, Duoresp Spiromax, and Symbicort?

A

Fostair: formoterol + beclometasone

Duoresp Spiromax: budesonide + formoterol

Symbicort: budesonide + formoterol

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9
Q

Which 2 brands of beclometasone inhalers should never be interchangeable, and why?

A

Qvar and Clenil

Qvar is x2 as potent as clenil due to extra fine particles, so these cannot be interchangeable

(Fostair also has extra fine particles like Qvar)

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10
Q

What is the max. expiry date for Fostair after dispensing?

A

3 months.

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11
Q

What should always be given to patients taking high ICS doses?

A

A steroid card

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12
Q

What specific side effect should patients be warned about when dispensing montelukast?

A

Report signs of neuropsychiatric reactions e.g. speech impairment, obsessive disorders, etc

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13
Q

Which LTRA antagonist must be reported for signs of liver toxicity?

A

Zafirlukast

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14
Q

What type of drug is theophylline?

A

It is a xanthine bronchodilator

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15
Q

What is the therapeutic range of theophylline, and when is a sample taken?

A

10-20mg/L, sample is taken 4-6h after dose given

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16
Q

What are the signs of theophylline toxicity?

A

Remember FAST and SICK

Vomiting/GI side effects
Tachycardia
Arrhythmia, convulsions, hypokalaemia

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17
Q

When should plasma theophylline levels be measured? What if it is an MR prep?

A

5 days after starting dose, and 3 days after any dose changes

If prep is MR, then sample should be taken 4-6h after first dose

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18
Q

What should you do to the dose of theophylline is the patient is a smoker?

A

Theophylline dose must be increased because smoking is enzyme inducing (which can lower theophylline levels)

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19
Q

Which specific mineral must be monitored if a patient is taking theophylline alongside a SABA?

A

Potassium levels

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20
Q

Which specific enzyme inhibitor can potentiate convulsions if given with theophylline?

A

Quinolones (e.g. ciprofloxaci), because it can lower the seizure threshold level

21
Q

What is the max number of puffs which can be taken in an acute asthma attack?

A

10 puffs in 10 minutes

22
Q

What is given during an acute asthma attack in hospital?

A

High dose SABA via oxygen-driven nebuliser (or SAMA)
O2 to maintain levels 94-98%
Oral prednisolone, or IV 200mg hydrocortisone

23
Q

How long is prednisolone given for an acute asthma attack for adults and children <12years?

A

Adult: 5 days (40-50mg OD)
Child <12yrs: 3 days

24
Q

What do you increase the risk of if a COPD patient is taking a SAMA + LAMA together?

A

Anticholinergic side effects

25
Q

What is the stepwise approach for COPD management?

A

Step 1: SABA/SAMA used in all stages as reliever

Step 2: LAMA + SABA, or LABA + SAMA

Step 3: Add theophylline

Step 4: Add ICS (risk of pneumonia)

26
Q

Which mucolytics can be used to loosen sputum and reduce sputum viscosity in COPD?

A

Carbocysteine
Acetylcysteine

27
Q

What is given during an acute COPD attack?

A

SAMA or SABA via nebuliser by air
O2 levels maintained 88-92% via a venturi 24% mask
Antibiotic therapy e.g. doxycyline, amoxicillin, or clarithromycin

28
Q

Which brand of inhaler contains ipratropium alone?

A

Atrovent

29
Q

Which inhalers contain tiotropium alone?

A

Spiriva respimat
Braltus

30
Q

Why should patients eyes be protected if they are given nebulised ipratropium?

A

Because there is a risk of acute angle-closure glaucoma

31
Q

What are some examples of old sedating antihistamines?

A

Promethazine
Chlorphenamine
Cyclizine
Hydroxyzine

32
Q

Which antihistamine has a risk of causing QT prolongation?

A

Hydroxyzine

33
Q

What are some examples of non-sedating antihistamines?

A

Acrivastine
Cetirizine
Loratidine
Fexofenadine

34
Q

Which antihistamine is found in migraleve specifically to reduce N+V?

A

Buclizine

35
Q

Which 2 antihistamines can be given after stabilisation during an anaphylactic reaction?

A

IV/IMChlorphenamine, or promethazine

36
Q

Which conditions are contra-indicated with the use of antihistamines?

A

Benign prostate hyperplasia
Glaucoma
Severe liver impairment

37
Q

What is the maximum dose of hydroxyzine for an elderly patient?

A

50mg

38
Q

What are some examples of drugs that can prolong QT interval?

A

Macrolides
Quinolones
Amiodarone
SSRI
TCAs
Lithium

39
Q

Which antibody is specific to allergy/atopic disorders?

A

IgE

40
Q

What are the doses of adrenaline for adult/child?

A

Adult/child >12yrs - 500mcg

Child 6-12yrs - 300mcg

Child <6yrs - 150mcg

41
Q

What are some adjuncts that can be given during anaphylaxis?

A

Chlorphenamine
High flow oxygen and IV fluids
Hydrocortisone injection

42
Q

What are some brands for adrenaline auto-injectors?

A

Jext
Epipen

43
Q

What is the treatment for angiodema (swelling of face)?

A

Adrenaline with oxygen
Antihistamine
Steroid

44
Q

Which 2 patient groups should you avoid prescriing carbocisteine for?

A

Pregnant women
Those with active peptic ulcers

45
Q

What is the usual dose of carbocisteine?

A

2.25mg OD, reduced to 1.5g in divided doses

46
Q

What is the 1st choice of mucolytic for a patient with cystic fibrosis?

A

Dornase alpha 2500 units OD by nebuliser

47
Q

Which condition is commonly found in patients with cystic fibrosis?

A

Exocrine pancreatic insufficiency

48
Q

What is the treatment for croup in a child 1 month - 2 years old?

A

Single dose of dexamethasone oral solution

GPhC Exam Revison (5 decks)

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